Chest Pain Flashcards
What chest pain conditions require immediate treatment? (3)
pericarditis
aortic dissection
pulmonary embolism
When encountered with a patient with chest pain, we ask the following questions: (5)
1.character of pain
2. exacerbating or relieving factors
3. ass. symptoms
4. duration, progression
5. decline in the threshold for severe anginal discomfort
describe pain occuring with myocardial ischemia impending infarction
- pain usually over 20 mins
- retrosternal area, radiats to the arms, back, neck, lower jaw
- squeezing, pressing, sensation of heaviness,
- breathing/posture does not notably influence the severity
symptoms can resemble ischemia - bradycardia, hypotension, dizziness, fainting (inferoposterior wall ischemia)
what symptoms are high risk?
- severe ongoing pain
- pain lasts more than 20 minutes
- new pain at rest or with minimal activity
- severe dyspnea
- loss of consciousness
what are features of pain that are not charactesrist of myocardial ischemia (7)
- pleuritic pain (bol koja se pogarsava disanjem i kasljanjem)
- primary or sole location of discomfort in the middle or lower abdominal region
- pain that may be localized at the tip of 1 finer, pogotovo preko apexa na lijevoj strani
- pain reproduced with movement or palpation of the chest wall or arms
- pain that lasts for many hours, constant
- brief episodes that last few seconds
- pain that radiates into the lower extremtities
list non-ischemic causes of chest pain (4)
- reflux
- pulmonary embolism
- aortic dissection
- costochondral pain
When is patient considered to have acute MI
When patients have new or presumably new ST elevation of greater than 1 mm in two contiguous leads, they should be considered to have acute myocardial infarction.
Patients with new or presumably new left bundle branch block (LBBB) should be treated how?
Patients with new or presumably new left bundle branch block (LBBB) should be treated similarly to those with ST segment elevation.
ECG criteria for STEMI (3)
- ST elevation >1mm in 2 or more adjacent limb leads or >=2 mm in 2 or more adjacent chest leads
- new LBBB
- posterior changes: deep ST depression and tall R waved in leads V1 to V3
when to refer a patient to a cardiologist? 6
- Means previous MI or other abnormalities
- The symptoms are not controlled by the prescribed therapy
- The presence of an ejection systolic murmur above aortic orifice
- Symptoms of unstable angina
- Uncertain or atypical symptoms
- Patients who will benefit from further examinations
Treatment of angina pectoris
A- aspirin, antianginal drugs, ACE inhibitors
B- beta-blockers, blood pressure pressure)
C- cessation of smoking (cessation smoking),cholesterol
D- diabetes mellitus, diet
E-exercise (physical activity), education
POST MI therapy : prior MI no heart failure
beta blocker, aspirin, ACEi, statins
Post MI therapy: prior MI with heart failure
beta blocker, aspirin, ACEi, statins, spironolactone, loop diuretics
post MI therapy, prior MI with DM
additionally intensive insulin therapy for 3 monthts
what to monitor post MI
renal function
serum potassium
lipids, AST, ALT, CPK
